Sindh province, Pakistan: 11 Naegleria fowleri deaths reported in 2023
5 cases reported in the US
Naegleria fowleri is a microscopic amoeba which is a single-celled living organism. It can cause a rare and devastating infection of the brain called primary amebic meningoencephalitis (PAM).
In southeastern Pakistan, the Sindh health department announced this weekend that 11 deaths due to infection with the amoebic parasite, Naegleria fowleri were reported in 2023.
One survivor of the lethal parasite was also reported.
There was also at least one case/death reported in Lahore in Punjab province.
This compares to seven deaths out of eight cases reported in all of 2022.
Pakistan is no stranger to Naegleria fowleri. Deaths related to primary amoebic meningoencephalitis (PAM) have been regularly reported from Karachi since 2008. At least 150 people have died of the disease in Pakistan over the past 14 years.
Naegleria fowleri is commonly found in warm freshwater such as lakes, rivers, ponds and canals.
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Infections can happen when contaminated water enters the body through the nose. Once the amoeba enters the nose, it travels to the brain where it causes PAM (which destroys brain tissue) and is usually fatal. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.
Naegleria fowleri infections are rare. Most infections occur from exposure to contaminated recreational water. Cases due to the use of neti pots and the practice of ablution have been documented.
The practice of ablution is included in Yogic, Ayurvedic, and Islamic traditions. Within the Islamic faith, ritual nasal rinsing is included in a cleansing process called “wudu” or “ablution.” It is usually performed several times a day in preparation for prayer, according to the Centers for Disease Control and Prevention.
Those infected with PAM will usually start showing symptoms about 5 days after the infection. It can often be mistaken for the flu or bacterial meningitis, as early symptoms include headache, fever, nausea or vomiting and can then progress to loss of balance, a stiff neck, seizures and hallucinations. The disease progresses quickly once the symptoms start and usually causes death within two weeks of the initial infection.
Pakistan isn’t alone in reporting cases and deaths from PAM. Five cases were reported in the United States in 2023—Arkansas, Texas, Georgia, Nevada and Florida, with the case in Florida surviving.
